椎弓根内固定结合伤椎植入固骼生治疗胸腰椎爆裂骨折  

Treatment of thoracolumbar vertebral body burst fracture with thanspedicular screw fixation and transplant of Novabone

作　　者：于晓川[1] 种衍学[1] 林峰[1] 李敏娜[1] 吕风云[1] 

机构地区：[1]山东省滕州市中心人民医院骨科,山东277500

出　　处：《脊柱外科杂志》2006年第5期274-277,共4页Journal of Spinal Surgery

摘　　要：目的探讨短节段经椎弓根内固定结合伤椎注入固骼生或异体骨治疗胸、腰椎体骨折的方法和效果。方法48例胸腰段脊柱骨折患者分为3组。均行后路复位短节段椎弓根内固定,伤椎椎体内植入固骼生(A组)或异体骨(B组),并与单纯后路短节段经椎弓根固定(C组)比较,于术后不同时间进行临床腰背痛VAS评分、神经功能分级及影像学观察伤椎体高度、矢状位指数(SI)。结果手术后1年患者伤椎体高度A组(0．96±0．03)、B组(0．95±0．03)高于C组(0．85±0．04),差异有显著统计学意义。手术后1年伤椎矢状位指数(SI)分别为8．12±1．80、9．47±3．63、18．67±3．84,A、B组与C组比较差异有显著统计学意义(P＜0．01)。手术后3个月A组VAS评分(1．41±0．67),C组为(1．33±0．67)低于B组(2．50±0．69),差异有显著统计学意义(P＜0．01),手术后12个月时C组VAS评分(1．60±0．77)与A组(0．71±0．42)相比差异有显著统计学意义(P＜0．01)、与B组(1．06±0．35)相比,差异有统计学意义(P＜0．05)。结论伤椎植入固骼生或异体骨结合胸腰段脊柱骨折复位固定手术可减少椎体高度角度丢失,预防手术后椎体塌陷及后凸畸形,伤椎植入固骼生还能减轻腰背疼痛。固骼生可作为伤椎的良好植入物。Objective To investigate the method and efficacy of the surgical treatment for thoracolumbar spine fractures by combining short-segment pedicle instrument fixation with transplanting Novabene or allograft into injured vertebrae. Methods Forty-eight patients with thoracolumbar fractures were random divided into three groups. Each group was treated with short- segment pedical screw fixation. The fractured vertebrae were then transplanted with Novabene in group A or allograft in group B after reduction and fixation. Group C with single posterior short-segment pedicle screw fixation served as controls. All groups were observed and compared by clinical trails and image assessment. Results The vertebral height of group A（0.96 ±0.03 ） and group B（0.95 ±0.03 ） were significantly higher than that of group C （0.85 ± 0.04 ） in the first postoperative year. The sagittal index （ SI ） of each group was 8.12 ± 1.80, 9.47 ± 3.63, 18.67± 3.84. The difference between group A and group B had no statistical significance. Both group A and group B have significant difference comparing with group C（ P 〈0.01 ）. No broken nail or stick was observed in group A. In the third postoperative month patients of group A and group C recorded little or no pain with an average VAS （ Visual Analog Scale） score off. 41 ± 0.67 and 1.33 ± 0.67 which were lower than that of group B（ 2.50 ± 0.69 ）. The difference had statistical significance （ P 〈 0.01 ）. There was significant difference between VAS score of group C （ 1.60 ± 0.77 ） and that of group A （0.71 ± 0.42 ） （ p 〈 0.01 ） in the first postoperative year. The difference between VAS score of group A and that of group B（ 1.06 ± 0. 35 ） had statistical significance（ P 〈 0.05 ）. Conclusions Transpedicular fixation of thoracolumbar vertebral bodies fractures and transplant of Novabone or allograft axe an effective methods to maintain vertebral height and prevent from the collapse of the vertebral body and kyphotic deformation. The

关 键 词：胸椎 腰椎 脊柱骨折 内固定器 

分 类 号：R683.2[医药卫生—骨科学]